P07-02 Prescription of adapted physical activity: expectations of patients consulting general practitioners in the department of Yvelines

Abstract Background Since 2016, French law has allowed general practitioners to prescribe adapted physical activity (APA) to patients with long-term health conditions. Studies have demonstrated that physicians are interested in this practice but very few have surveyed patient expectations. Objective The objective of this work was to study patients' expectations regarding the prescription of APA. Methods This is a quantitative descriptive study treating data obtained from a survey carried out in general practice offices in the department of Yvelines between June and September 2019. The inclusion criteria for patients were: above 18 years old and present in the waiting room. Results 252 patients were surveyed in 9 doctors' offices. We received 90% of responses. Prescription of APA is a good idea for 95.2% of patients, 80.2% were motivated to join an APA program and 67.4% thought that prescription of APA would increase their motivation. The main constraints to physical activity practice were lack of time (59.9%) and lack of motivation (31.7%). The main practices that would help patients to better adhere to an APA program were group sessions supervised by a professional (64.7%) pursued by a follow up with their doctor (41.7%). 53.2% of patients considered that it would be important to monitor their physical activity through a connected device. Factors independently associated with the motivation to participate in the APA program were a female gender (p > 0.01), a bachelor's degree (p = 0.01), a general opinion that prescription of physical activity is a good idea (p > 0.01). Conclusion Our results revealed an enthusiasm with patients for APA prescription, which is interesting for the promotion of PA in general medicine.


Background
Understanding the common facilitators and challenges experienced by those implementing physical activity (PA) interventions in Ireland is crucial for both promoting good practices and solutions to overcome such challenges in the future. The purpose of this study was to interview relevant stakeholders to identify factors associated with implementing PA interventions in Ireland. Methods Semi-structured interviews were conducted with service providers, coordinators, funders, researchers and policy makers involved with selected PA interventions (N = 11) in Ireland. The Consolidated Framework for Implementation Research (CFIR) was used to guide the generation of an interview script including key questions and prompts. Prompts were identified through a short survey that was completed by participants before the interview. Interviews lasted approximately one-hour and were conducted by the same interviewer, either in person or over the phone, and recorded using a Dictaphone. All interviews were transcribed and cleaned before being analysed using NVIVO. Open coding, using the CFIR domains as a guide, was used to generate and agree on a code book to analyse all interviews. Once open coding was complete, thematic analysis was used to identify themes in the data related to implementation facilitators and challenges.

Results
Thirty-eight purposely sampled participants took part in the semi-structured interviews (26.3% service providers, 31.6% coordinators, 10.5% funders, 15.8% researchers, 15.8% policy makers). Some themes related to 1) intervention characteristics included usability, costs, fidelity and practical considerations, 2) characteristics of individuals included constraints, knowledge and attitudes, 3) inner setting included support, staffing, understanding or awareness, 4) outer setting included role responsibility, context changes, partnerships, 5) processes of implementation included advertisement, deliver and scale-up. Relationships were also noted between themes. For example, themes identified for funding and stakeholder engagement were found to influence multiple domains of the CFIR framework.

Conclusion
Findings from these interviews help to understand the complexity of implementing PA interventions in the Irish context. Furthermore, the findings can be used to aid implementation through the facilitators identified and provide solutions to common challenges experienced by those involved

Physical activity
Abstract citation ID: ckac095.101 P07-01 Prescription of adapted physical activity: knowledge and needs among general practitioners of Ile-de-France

Background
Physical inactivity is the fourth leading cause of death in the world. In France, the concept of medical prescription of physical activity (PA) adapted now appears in a law which specifies the central role of the family physician since December 2016. The needs of the general practitioners (GP) about prescription of PA has not been studied. Aim To assess the knowledge and needs of GPs regarding the medical prescription of PA. Methods This is a transversal observational epidemiological study of GPs working in the departments of Hauts-de-Seine (92) and Val-de-Marne (94) near Paris. A questionnaire was sent by mail or email. A descriptive statistical analysis was conducted to describe the main variables of interest. Then, a multivariate statistical analysis by logistic regression was conducted to look for independent factors of the feeling of competence in the prescription of adapted PA. Results 158 physicians were included. 72.2% of GPs rated their knowledge in PA as average to very poor. The initial training in PA is estimated as unsatisfactory by 84.2% of GPs. 81.6% haven't done a postgraduate additional training in PA. A specific skill in sports medicine, the individual practice of PA as well as the speaking about PA in more than 50% of Abstract citation ID: ckac095.102 P07-02 Prescription of adapted physical activity: expectations of patients consulting general practitioners in the department of Yvelines

Background
Since 2016, French law has allowed general practitioners to prescribe adapted physical activity (APA) to patients with long-term health conditions. Studies have demonstrated that physicians are interested in this practice but very few have surveyed patient expectations. Objective The objective of this work was to study patients' expectations regarding the prescription of APA.

Methods
This is a quantitative descriptive study treating data obtained from a survey carried out in general practice offices in the department of Yvelines between June and September 2019. The inclusion criteria for patients were: above 18 years old and present in the waiting room. Results 252 patients were surveyed in 9 doctors' offices. We received 90% of responses. Prescription of APA is a good idea for 95.2% of patients, 80.2% were motivated to join an APA program and 67.4% thought that prescription of APA would increase their motivation. The main constraints to physical activity practice were lack of time (59.9%) and lack of motivation (31.7%). The main practices that would help patients to better adhere to an APA program were group sessions supervised by a professional (64.7%) pursued by a follow up with their doctor (41.7%). 53.2% of patients considered that it would be important to monitor their physical activity through a connected device. Factors independently associated with the motivation to participate in the APA program were a female gender (p > 0.01), a bachelor's degree (p = 0.01), a general opinion that prescription of physical activity is a good idea (p > 0.01).

Conclusion
Our results revealed an enthusiasm with patients for APA prescription, which is interesting for the promotion of PA in general medicine. Keywords: physical activity prescription, patient, primary care, general practice Abstract citation ID: ckac095.103 P07-03 The characteristics of the medical prescription for adapted physical activity among the French Health System, experience of the Grand Est region Bruno Chenuel 1,2 1 Center of Sports Medicine and Adapted Physical Activity, University Hospital of Nancy, Vandoeuvre-lè s-Nancy, France 2 DevAH -Department of Physiology, University of Lorraine, Vandoeuvre-lè s-Nancy, France Corresponding author: b.chenuel@chru-nancy.fr

Issue/problem
The law of modernization of the French health system promoted in 2016 have authorized any attending physician to prescribe a program of physical activity suitable for patients with a chronic disease. The health benefits of active living habits are now well known but too few physicians have seized this prescription of Adapted Physical Activity (APA). Description of the problem APA teachers have come to complement the health professions to deliver APA, and sports clubs have improved their organization to welcome patients who have adequate physical condition. Regional systems have been deployed to receive patients, using such resources. The 'Médicosport Santé' guide provides relevant guidance for patients according to physical and/or sporting activities (PSA) and diseases. The medical prescription for APA must therefore become a practical reality for chronic disease patients, guaranteeing a lasting change in lifestyle through more active behavior. Experience from the Grand Est country The commitment of certain French Regional Health Agencies, has led certain regions to offer regional systems, as the ''Prescri'mouv'' plan in the Grand Est country, allowing a step forward to best support the patient from the medical prescription to regular and lasting practice. After medical prescription, patients are directed to an APA professional or physiotherapist, for an initial evaluation and orientation towards one of the three types of care: autonomous practice, labeled structure, specific support.

Lessons
The main objective of APA is to fight against a sedentary lifestyle. With an adequate physical condition, physical activities and sports are to be considered in order to help patients with chronic disease, sources of pleasure and lasting health benefits. New actors have come to strengthen health professionals, and through 'Sport Santé' concept, sports clubs have organized themselves to welcome patients.

Main messages
Adapted physical activity is the keystone in the fight against sedentary lifestyle. New players have come to strengthen health professionals, sports clubs have organized themselves to welcome of and best support patients with chronic disease. The challenge is for physicians to take hold of this medical prescription for APA, by directing patients towards more

Background
With the first initiatives dating back to the 1990s, the past two decades have seen a rapid increase in the use of exercise referral schemes (ERS) worldwide. Despite the accumulating evidence on their effectiveness, there are currently no international guidelines available to inform the design of such interventions.
The key elements and processes employed vary both within and between countries. This systematic review aims to address this frequently overlooked topic by identifying elements that are predominant in international ERS. Methods Scientific databases (PubMed, Scopus) and grey literature sources were systematically searched. In order to collect the information relevant for understanding and visualizing all ERS models, a broad spectrum of document types was considered eligible for inclusion, i.e. randomized controlled or pragmatic trials, cohort studies, case-control studies, case series, case reports, qualitative studies, economic evaluations, mixed designs, policy documents, and official governmental reports. We extracted data on scheme components, contents, and main actors involved in scheme delivery. Cross-functional flowcharts were employed to facilitate comparison between different ERS designs: Firstly, the collected data were visualized in flowcharts indicating the pathway a patient follows from beginning to end of an individual ERS. Secondly, elements that appeared more frequently across all included ERS were identified.

Results
Preliminary results identified 18 models of ERS that were eligible for data analysis, including Green Prescription (New Zealand), Hreyfiseôill (Iceland), National Exercise Referral Scheme (Wales). Program designs ranged from short advice by a primary healthcare professional to physical activity prescription and/or further referral to affiliated health professionals. The prevailing actors involved in scheme delivery were physicians, nurses, physiotherapists, training experts, physical activity providers, and coordinators. Seven predominant elements emerged from the comparison between ERS designs: assessment, counselling, individualized physical activity recommendations, written prescription, behavior change techniques, support person, and follow-up.

Conclusions
To the best of our knowledge, this is the first study that takes a closer look at the design characteristics of ERS across the world. Our preliminary results indicate that there are seven key elements. The contribution of these elements on the effectiveness of ERS needs to be explored in future research.